Neutrophil-mediated immunity is the first host defense response against any infection. Crevicular efflux of neutrophils against bacteria is considered to be a novel defense mechanism in periodontal diseases. As a part of defense mechanism, neutrophils extrude its content and exhibit its antimicrobial activity by forming a web-like structure called neutrophil extracellular trap (NET) and undergo a process of cell death called NETosis. Under physiological conditions, NET production is limited and is balanced with its degradation, whereas NET production is found to be aggravated in chronic systemic inflammatory conditions such as diabetes mellitus and also in periodontal diseases. It is well known that a two-way relationship exists between diabetes mellitus and periodontal diseases. Interference in the process of NETosis might form a link between the two. The aim of this review is to focus on the potential role of NETosis in the pathogenesis of periodontitis and diabetes mellitus.

Background: The study aimed to determine the presence of publication bias in the top five dental journals with high impact factor published during 2007–2016. Materials and Methods: The journals included are Journal of Clinical Periodontology, Dental Materials, Clinical Oral Implant Research (COIR), Journal of Endodontics, and Journal of Dental Research (JDR). The content of these journals was hand searched by two authors for scouring the proportion of positive or negative results. Articles showing two outcomes (primary and secondary) were registered depending on the primary result. Results: The present study revealed higher percentage of statistically significant results in the published dental literature. Of five journals, JDR has shown fewer tendencies toward publication of nonsignificant results, whereas COIR has evidenced the highest publication of nonsignificant results. The journals with higher impact factor showed significantly different acceptance rate for research with positive results. However, year-wise publication (2007–2016) did not depict any significant difference. Conclusion: In dental research journals, articles with positive results are finding a better way in getting published compared to articles with negative results.

Background: Recent evidence suggests the interactions between bacterial DNA and nucleic acid receptors to play a role in inflammatory tissue destruction. The current study aims to evaluate the expression of Toll-like receptor 9 (TLR9) in periodontal disease associated with or without hyperlipidemia and to associate it with the presence of Porphyromonas gingivalis.Materials and Methods: Thirty participants in the age range of 25–50 years were randomly recruited and divided into three groups, i.e., healthy (Group I), chronic periodontitis without hyperlipidemia (Group II), and chronic periodontitis with hyperlipidemia (Group III). The gingival tissue samples were analyzed for TLR9 using immunohistochemistry, and plaque samples were analyzed for P. gingivalis using polymerase chain reaction. Results: The TLR9-positive cell ratio in gingival connective tissue for Group II and Group III was 0.95 ± 0.03 and 0.94 ± 0.03, respectively, which was significantly higher than that of Group I, with P < 0.001 (0.88 ± 0.04). These groups also demonstrated significantly higher presence of P. gingivalis as compared to Group I with P < 0.001. There was a positive association between TLR9 in gingival connective tissue and presence of P. gingivalis. Conclusion: The results of this study reveal a potential role of TLR9 in chronic periodontitis, in association with P. gingivalis. Furthermore, these variables do not show an appreciable change in hyperlipidemics suggesting a weak relation between TLR9 and lipid levels.

Background: The purpose of this 2-year prospective survival analysis study is to determine a statistically validated periodontal prognostic score for diseased molars in smokers using the Miller-McEntire Periodontal Prognostic Index (MMPPI). Materials and Methods: Two hundred molars were evaluated from 25 patients who were smokers with moderate-to-severe chronic periodontitis. The factors evaluated included age, probing depth, mobility, furcation involvement, smoking, and molar type. A modified, 5 level, scoring criterion for smoking based on smoking-dose was adopted. MMPPI was computed as the sum of scores for all six prognostic factors. Appropriate periodontal treatment and supportive periodontal therapy were provided. All patients were evaluated at baseline and 2 years posttreatment. Hazard risk ratio (HR) was computed for each prognostic factor. Results: A total of 3 (1.5%) teeth of the 200 molars were extracted over the 2-year follow-up duration, with a mean of 0.015 teeth lost. The HR was found as significantly higher for three individual prognostic factors: mobility (HR = 5.57, P = 0.02), smoking (HR = 3.35, P = 0.04), and furcation involvement (HR = 7.30, P = 0.01). Significant and positive HR (HR = 1.70, P = 0.01) was noted for the total MMPPI score, validating its prognostic value for molar survival at 2 years prospectively. Conclusions: The findings of the current study demonstrate the prognostic validity of MMPPI incorporating a more detailed smoking score criterion. The factors smoking, furcation involvement, and mobility significantly impacted the likelihood of survival of periodontally diseased molars. Further studies with a larger sample size and longer follow-up are required to confirm these findings.

Background: The hyperoxidative and a modified inflammatory state in obese individuals cause higher susceptibility to bacterial infection which influences the initiation and progression of periodontal disease. Aim: Our study was aimed to evaluate the role of nonsurgical periodontal therapy on the clinical parameters such as gingival index (GI), plaque index, pocket probing depth (PPD) and clinical attachment level (CAL), plasma-reactive oxygen metabolite (ROM) levels, and gingival crevicular fluid (GCF) resistin and serum resistin levels in obese or overweight and normal weight individuals with periodontitis. Material and Methods: Sixty individuals of age between 35 and 45 years of both the sexes were selected and categorized into two groups as thirty overweight or obese individuals with chronic periodontitis (Group I) and thirty normal weight individuals with chronic periodontitis (Group II). Clinical parameters, plasma ROM levels, and serum and GCF resistin levels were assessed at baseline and 2 months after periodontal therapy in both the groups and compared. Results: Intergroup comparison of clinical parameters (GI, CAL, PPD) 2 months after therapy showed a significant difference with more reduction in Group II compared to Group I. On comparison, mean plasma ROM, GCF, and serum resistin levels at baseline was higher in Group I compared to Group II. When plasma ROM, GCF, and serum resistin levels were compared 2 months after therapy, the reduction was more in Group II compared to Group I. Conclusion: It is concluded that along with periodontal therapy, motivation of patients for weight reduction program is mandatory for obese or overweight individuals with periodontitis in order to improve periodontal health.

Aim: The aim of the present study is to compare the amount of remaining calculus, loss of tooth substance, and roughness of root surface after scaling and root planing with or without magnification loupes using scanning electron microscope. Materials and Methods: In the study, 30 teeth indicated for extractions due to severe chronic generalized periodontitis were included in the study. In test Group I, scaling and root planing was performed without magnification loupes, and in test Group II, scaling and root planing was performed with magnification loupes before extraction. In control Group III, no procedure was performed. After scaling and root planing, teeth were extracted followed by preparation of specimens. Specimens were then sent for scanning electron microscope study. Results: Statistically significant (P ≤ 0.05) differences were found among different test groups. Results showed that test Group II with magnification loupes had less remaining calculus and smoother surface with lesser amount of loss of cementum layer. Conclusion: From this, it was concluded that test Group II was more efficient in root debridement than test Group 1, so scaling and root planing done with magnification loupes will cause less damage to the tooth surface.

Background: The management of the furcation areas in multirooted teeth is often challenging due to difficulty in access. Platelet-rich fibrin (PRF), a second-generation platelet concentrate, has shown to accelerate the healing of soft and hard tissues. This study was designed to evaluate the efficacy of autologous PRF as a membrane in treatment of Grade II furcation defects in molars as compared to collagen membrane along with demineralized freeze-dried bone allograft in both the groups. Materials and Methods: A split-mouth study was planned with 18 patients having 2 sites of Grade II furcation defects each. Random allocation of the defect site was done for the test and control group. Plaque index, probing depth (PD), relative vertical clinical attachment level (RVCAL), gingival marginal level, and radiographic bone levels were recorded at baseline, 3 months, and 6 months postoperatively. Results: Both the groups showed statistically significant outcomes in intragroup comparison from baseline to 3 and 6 months. However, there was no statistical difference between PRF membrane and collagen membrane groups on intergroup comparison. Conclusion: There was a significant reduction of PD, improvement in RVCAL, and defect fill with autogenous PRF as membrane. This indicates its role as a regenerative material in treating furcation defects, which can be used as alternative to other expensive membranes.

Context: The orthodontic treatment in adult for the treatment of malocclusion is becoming more common. However, the disadvantages of conventional orthodontics are the time consumed for the treatment (18–24 months), root resorption, and formation of fenestrations and dehiscence. Periodontally accelerated osteogenic orthodontics (PAOO) is a surgical technique resulting in increased alveolar bone width, shorter treatment time, increase posttreatment stability, and decrease amount of apical root resorption. Aim: The aim of the study is to compare the treatment time, root resorption, bone density, and presence/absence of fenestrations and dehiscence after PAOO with surgical bur and PAOO with piezocision. Materials and Methods: Forty participants with bimaxillary protrusion undergoing orthodontic treatment were randomly selected and divided into two groups. Group I: 20 participants selected for PAOO with surgical bur and Group II: 20 participants selected for PAOO with piezocision. Patients were recalled at baseline 3, 6, 9, and 12 months and evaluated for treatment time and bone density, root resorption, and detection of fenestration and dehiscence using cone-beam computerized tomography (CBCT). Results: Participants in Group I had less treatment time compared to Group II. Rate of retraction was 7.07 mm/20.81 weeks and 5.99 mm/28.48 weeks in Group I and Group II, respectively. CBCT showed a statistically significant increase in bone density in both groups, 12 months after the surgery. Root resorption was negligible in Group I (0.34 mm) and in Group II (0.51 mm). CBCT revealed increase in thickness of alveolar bone and coverage of fenestrations and dehiscence. Conclusion: PAOO provides an efficient and stable orthodontic tooth movement.

Context: Rehabilitation of jaws with reduced bone height is technically demanding and expensive. Short implants are emerging as an alternate in such cases. Aim: This study aimed to evaluate the survival of implants of 8 mm in length (short implants), clinically and radiographically, in posterior resorbed ridges. Materials and Methods: A total of 11 patients with single missing posterior tooth, having 9–10 mm of residual bone height determined using radiographs, were selected for the study. Twelve implants of 8 mm length were inserted in the resorbed alveolar ridges following standard operating procedure. A second-stage surgery was performed 4–6 months after implant placement for placement of gingival former. This was followed by placement of prosthesis. Twelve months after prosthesis placement, all the patients were examined clinically and radiographically. Results: According to Albrektsson et al.'s criteria, all implants were successful with mean bone loss of 1.1 ± 0.32 mm mesially and 0.83 ± 0.35 mm distally with healthy gingival condition at 12-month follow-up. Conclusion: Short implants (8 mm in length) can be a viable alternative in cases of atrophic alveolar ridges.

Background: Mechanical scaling is the most common treatment of periodontal and peri-implant tissue infections. Aims: This study aimed to evaluate the effect of mechanical prophylactic therapy on the residual stresses in the implant and hand scaler. Settings and Design: For finite-element analysis, an implant-supported prosthesis was created using modeling software with 3 mm of exposed threads. For simulation of a prophylactic mechanical debridement, the active face of the shank was disposed of in contact with the last thread exposed at a 90° angle. Materials and Methods: In the analysis software, the contacts were defined as rough between the instrument and the implant. The cortical bone was fixed and a load of 10 N was applied to the instrument cable. Two simulations were performed according to the instrument material: stainless steel or Teflon. Von-Mises results were obtained. Statistical Analysis Used: No statistical test was used, but, the 500 higher stress peaks in the implant and in the instrument were analyzed for qualitative comparison. Results: Mechanical prophylactic therapy generates higher residual stress on the implant with a stainless steel instrument. There was no difference between the materials for the active tip of the instrument, and the active portion of the shank was the region which concentrated more stress. Conclusions: It is suggested that hand scalers in Teflon are less damaging to the implant, but more susceptible to deformation and possible early failures.

Purpose: Kharra is a mixture of areca nut and tobacco. Arecoline, an areca nut extract, disrupts the harmony of the periodontal cells and thus leads to destruction of the periodontium. Oral submucous fibrosis (OSMF) is a premalignant condition that arises due to the consumption of kharra. The aim of this study was to evaluate and compare the effects of kharra chewing on periodontal status in patients with OSMF. Materials and Methods: Forty-five patients were divided into Group I: healthy periodontium (n = 15), Group II: chronic periodontitis without OSMF group (n = 15), and Group III: chronic periodontitis with OSMF group (n = 15). The clinical parameters assessed for patients with chronic periodontitis were gingival index (GI), plaque index (PI), probing pocket depth (PPD; overall and regional) ≥3 mm, and clinical attachment level (CAL; overall and regional) ≥3 mm. For patients in Group III, the OSMF diagnosis and staging were based on Khanna's classification. The level of significance was set at P < 0.05. Results: The sample with a mean age of 35 years had a frequency of chewing kharra >6 times per day for at least 3 years. PI, PPD and CAL in Group III were 2.1 ± 0.4, 3.2 ± 0.6, and 4.8 ± 0.6 mm, respectively. the results of the clinical parameters in Group III and Group II were higher than Group I. GI was higher in Group II as compared to the other groups. Conclusion: The habit of chewing kharra is found to be associated with poor periodontal health in patients with OSMF.

Subepithelial connective tissue graft (SCTG) presents favorable outcomes. However, the harvesting technique can influence the anatomical and histological composition of the SCTG. Within the limitations of a case report, the behavior of SCTGs removed by two techniques was evaluated bilaterally in one patient using double blade scalpel (DBS) and de-epithelialized graft (DE). Clinical parameters, laser Doppler flowmetry (LDF) and histological analysis were assessed. Complete root coverage was observed bilaterally, as well as improvement in width and thickness of keratinized tissue 2 years postoperatively. The LDF analysis demonstrated better revascularization in the DBS recipient area compared to DE. The histological evaluation showed differences in tissue composition and organization of collagen fibers. Similar clinical outcomes were observed bilaterally, nevertheless greater morbidity and aesthetic was reported in the DE harvesting area.

Intentional re-implantation is the careful removal and re-insertion of an endodontically treated tooth performed with an attempt to preserve the natural dentition and patients' esthetic concerns. Its limited success rate and a possibility to obtain undesirable outcomes such as root resorption and ankylosis of the tooth restrict its clinical use to be attempted only as a last option after routine procedures. A vast array of procedures have been performed till date with inconsistent results due to lack of analogous protocols followed. Regardless of having a controversial background behind its success in periodontally compromised teeth, this procedure raises a hope to avoid unwarranted natural tooth loss. Performing each step with precision governs the success of the treatment. This case report demonstrates two different techniques with an interdisciplinary approach assessed over 1 year each.

Pyogenic granuloma (PG) is an inflammatory hyperplastic lesion of the oral cavity. The most common etiological factors for PG are low-grade local irritation, traumatic injury, or hormonal factors. Clinically, it appears to be smooth or lobulated exophytic lesion. It appears to be erythematous papule and is either pedunculated or has a sessile base. The lesion has shown a recurrence rate of 15.8%. Various treatment modalities have been present in the literature. The present article emphasized the treatment modalities and an effort to treat the recurrence of PG with the use of platelet-rich fibrin (PRF) membrane. This case report presents a 28-year-old female patient who had reported with PG that recurred twice in 2-year period. The lesion appeared to be recurrent with sessile base and was diagnosed clinically and histopathologically as PG. The PG was excised with the conventional scalpel method exposing the underlying bone. The exposed surface was then covered with PRF membrane. At 12-month follow-up period, the patient did not show any further recurrence of the lesion.

Coverage of the exposed root is one of the periodontal plastic surgical procedures, which is one of the important periodontal treatment modalities. The introduction of innovation in new interdisciplinary treatment modalities has allowed us the use of orthodontic button in root coverage procedures using a coronally advanced flap (CAF) to provide the initial stabilization. This case report also evaluates the effectiveness of low-level laser therapy (LLLT) to detect the microvascular blood flow changes in the gingiva and alveolar mucosa where LLLT has been given after button-anchored CAF procedure during postoperative healing to detect blood flow changes of mucosa where LLLT was not given in other surgical sites. Three-month postoperative results showed that the LLLT used as an adjunct to CAF with the orthodontic button for stabilization is an effective surgical approach in the management of Miller's Class I recession defects.